The Journal of Bone and Joint Surgery, Vol 70, Issue 4 569-580, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Treatment of symptomatic flatback after spinal fusion
MO Lagrone, DS Bradford, JH Moe, JE Lonstein, RB Winter and JW Ogilvie
Orthopaedic Service, Letterman Army Medical Center, Presidio San Francisco, California 94129.
Fifty-five patients who had loss of lumbar lordosis after spinal fusion and
subsequently had corrective osteotomies were studied. When they were first
seen, fifty-two patients (95 per cent) were unable to stand erect and
forty-nine (89 per cent) had back pain. The previous use of distraction
instrumentation with a hook placed at the level of the lower lumbar spine
or the sacrum was the factor that was most frequently identified as leading
to the development of the flatback syndrome. Sixty-six extension
osteotomies were performed in these fifty-five patients. Nineteen patients
(35 per cent) had an associated anterior spinal fusion. Thirty-three
patients (60 per cent) had one or more complications, including
pseudarthrosis, a dural tear, failure of hardware, neurapraxia, and urinary
tract infection. The results of the operation were evaluated at follow-up
by review of clinical records, radiographs, and questionnaires. At an
average follow-up of six years (range, two to fourteen years), most
patients felt that they had benefited from the corrective osteotomies.
However, twenty-six patients (47 per cent) continued to lean forward and
twenty patients (36 per cent) continued to have moderate or severe back
pain. The failure to restore sagittal plane balance led to a higher rate of
pseudarthrosis, which was associated with recurrent deformity. Anterior
spinal fusion combined with posterior osteotomy resulted in greater
maintenance of correction. The prevention of flatback syndrome is
important, since its treatment is difficult. When a spinal fusion must be
extended to the level of the lower lumbar spine or the sacrum, the use of
distraction instrumentation should be avoided in order to prevent this
deformity.
CiteULike 
Connotea 
Del.icio.us 
Technorati What's this?
